COVID-19 UPDATE #227
February 11, 2022
GUIDANCE ON IMPLEMENTING ADDITIONAL PRECAUTIONS FOR UNVACCINATED STAFF UNDER CMS VACCINE MANDATE
The Centers for Medicare and Medicaid Services (CMS) staff vaccination rule requires facilities to take additional precautions for those staff who remain unvaccinated due to a medical/religious exemption. CMS provides a list of additional precautions in QSO memos QSO-22-07-LTC, QSO-22-09-LTC, and QSO-22-11-LTC.

It is important to keep in mind that facilities are not required to follow all the precautions listed by CMS in the QSO memo. However, they should be intentional about establishing appropriate policies around additional precautions and take a layered approach based on risk of COVID-19 transmission to residents they serve. For example, facilities may choose to test all unvaccinated staff at a higher frequency than required by CMS or CDC guidance, but only require unvaccinated staff with direct contact with residents to wear N95 masks. 

In addition, facilities may want to reassign unvaccinated frontline caregivers to residents who are not at particularly high risk for negative outcomes due to COVID-19. Read more.
CMS POSTS UPDATED SNF QRP PUBLIC REPORTING TIP SHEET
CMS has posted a second edition of the COVID-19 Public Reporting Tip Sheet. This resource will help providers understand CMS’ approach to the SNF Quality Reporting Program to account for CMS quality data submissions that were either optional or excepted from public reporting due to the COVID-19 public health emergency. Read more.
NEW GUIDANCE FOR HEALTH CARE PROVIDERS ON CIVIL RIGHTS PROTECTIONS FOR PEOPLE WITH DISABILITIES
HHS has issued guidance to health care providers on civil rights protections for people with disabilities. The guidance makes clear that in light of the continuing public health emergency, when resources can be scarce, it is vital that individuals with disabilities are not prevented from receiving needed health care benefits and services. Read more.
DEAR ADMINISTRATOR LETTERS UPDATE SKILLED NURSING PROVIDERS ON EMERGENCY RULES AND VISITATION REQUIREMENTS
In a Dear Administrator letter dated February 10, 2022, skilled nursing providers are informed that they must follow the Safe Start: Long Term Care COVID Response Plan. The Centers for Medicare and Medicaid Services (CMS) released QSO-20-39-NH REVISED providing updated visitation guidance in nursing homes, and that has caused some confusion. The letter states, "To clarify, if there is a difference between state and federal guidance, NHs must follow the more restrictive guidance (Safe Start Plan, page 2). Because of this requirement, providers must follow the October 7, 2021 Safe Start Plan for visitation requirements to reduce the transmission of COVID-19."

In a Dear Administrator letter dated February 11, 2022, skilled nursing providers are informed that the Department filed a CR-103E (WSR 22-04-038), effective February 3, 2022, to extend the amended rule related to fire drills, windows in resident rooms and quality assurance requirements. The rule expires on May 26, 2022. These are the amended rules:
  • WAC 388-97-1740 waives the requirement for periodic fire drills. Training on responding to a fire is still required.
  • WAC 388-97-1760 reduces the scope of quality assurance activities. Facilities must continue to review adverse events and infection control.
  • WAC 388-97-2400 waives the requirement for a transparent glass window. This will increase the ability for facilities to increase capacity temporarily by utilizing windowless space for resident rooms.

If providers have questions about either of these letters or the subject matter related to each, please email Molly McClintock, NH Policy Program Manager, or call her at (360) 742-6966.
HELSA PROVISIONS FOR HEALTHCARE FACILITIES
The Department of Labor and Industries (L&I) is seeking to codify into rule certain reporting requirements that have up to now been in session law and RCW. Healthcare was previously excluded from this requirement as L&I had planned on rolling it into a more comprehensive emergency rule for healthcare. L&I is no longer looking to issue such an emergency rule and is instead waiting on a permanent rule from federal OSHA.

Reporting requirements come from HELSA (Health Emergency Labor Standards Act, SB 5115) and are in two parts.

All employers with more than 50 employees at a worksite must report outbreaks of 10 or more positive employee cases of COVID-19 to DOSH. Case count begins when the second positive employee test in 14 days occurs and continues until either 10 positive tests are reached or 28 days have passed without a new positive test. The outbreak need only be reported once to DOSH (meaning further cases after you have reached outbreak status do not need further reporting) and is reported through the normal DOSH reporting line (1-800-423-7233). Outbreaks must be reported within 24 hours of knowledge of meeting the DOSH criteria (outlined above) for employee outbreak status. For DOSH reporting purposes, the outbreak is considered over when 28 days have passed with no new employee positive tests. This reporting does not replace or meet other reporting requirements to DSHS/RCS, your LHJ, and/or NHSN as applicable for your healthcare setting.

The second DOSH reporting requirement mandates all healthcare employers, regardless of size, notify any employee within 24 hours if they have known or suspected high-risk exposure to an infectious or contagious disease that is the subject of a public health emergency. High-risk exposure is defined as any of the following without wearing a fit-tested respirator and all other required PPE:
 
  • Within six feet of a qualifying individual for a cumulative 15 minutes or more in a 24-hour period during the individual’s transmission period.
  • In the same room as a qualifying individual undergoing an aerosol-generating procedure. A list of aerosol-generating procedures is found here.
  • In the room where a qualifying individual underwent an aerosol-generating procedure, prior to the end of the clearing time based on CDC guidelines for 99.9% removal efficiency. The maximum clearing time is 3 hours following the conclusion of the procedure. For clinical spaces contracted by DOH with 6 air exchanges per hour 1 hour is sufficient. For airborne infection isolation rooms (AAIRs) 15 minutes is sufficient.

A qualifying individual is anyone with a positive lab test, positive diagnosis, or an order to isolate by a public health official, or died by an infectious or contagious disease that is the subject of a public health emergency. For COVID-19, a qualifying individual’s transmission period is two days before the onset of symptoms (or two days prior to test specimen collection for asymptomatic people) until they leave the worksite.

If your workplace has a union, the employee may authorize notification of union representatives.
DOH UPDATED GUIDANCE INFORMATION
The Department of Health (DOH) continues to work through updates to DOH guidance in consideration of the recent CDC guidance changes. DOH has updated three pieces of guidance to reflect current evidence and updated CDC guidance:

Providers may contact Larissa Lewis with questions.
DOH PROVIDES UPDATED MEDICAL MATERIAL CATALOG
The Department of Health (DOH) has provided the updated Washington State Department of Health Medical Material Catalogue. Items within the catalogue are available for request through Local County Emergency Management Agency.
ADDITIONAL RESOURCES
WHCA continues to post resources and information as it becomes available on our website. If you have questions or need additional information, please call the WHCA office at (800) 562-6170.